Provider Demographics
NPI:1861944050
Name:LEONE, KAITLYN M (CRNP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:M
Last Name:LEONE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:M
Other - Last Name:KARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11185 EDINBORO RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:EDINBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16412-1080
Mailing Address - Country:US
Mailing Address - Phone:814-983-7818
Mailing Address - Fax:814-200-8266
Practice Address - Street 1:2500 PALERMO DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7206
Practice Address - Country:US
Practice Address - Phone:814-860-3179
Practice Address - Fax:814-616-7400
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
13943087OtherCAQH
PA103227450Medicaid